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Medicaid Recipient Handbook - dhss.alaska.gov

Department o f Health and Social Services DIVISION OF HEALTH CARE SERVICES Director s Office 4501 Business Park Blvd., Suite 24, Bldg L Anchorage, alaska 99503-7167 M ain: Fax : Dear Fellow Alaskan, As Director of the Division of Health Care Services, I am pleased to provide you with this Handbook of information regarding health care programs for financially eligible Alaskans. The purpose of this Handbook is to help you understand available programs and, if you are eligible , how to effectively use the coverage . This Handbook is not designed to provide detailed and individua l information, but instead to offer a broad overview of the program and services available.

have any other type of health care coverage. Some other sources of health coverage include: Employment-related health insurance, either the recipient’s or that of a family member Individually purchased health insurance Veterans Administration (VA) benefits Medicare Parts A, B, C, and D Tricare/Tricare for Life

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Transcription of Medicaid Recipient Handbook - dhss.alaska.gov

1 Department o f Health and Social Services DIVISION OF HEALTH CARE SERVICES Director s Office 4501 Business Park Blvd., Suite 24, Bldg L Anchorage, alaska 99503-7167 M ain: Fax : Dear Fellow Alaskan, As Director of the Division of Health Care Services, I am pleased to provide you with this Handbook of information regarding health care programs for financially eligible Alaskans. The purpose of this Handbook is to help you understand available programs and, if you are eligible , how to effectively use the coverage . This Handbook is not designed to provide detailed and individua l information, but instead to offer a broad overview of the program and services available.

2 It is also important to understand that this is only a guide and is not intended to determine eligibility. There are many factors that must be taken into consideration. Each person s situation is different, and there are many categories of Medicaid , each with its own set of eligibility rules. Final determination of eligibility is made by the state Division of Public Assistance. See the back of this booklet for the Public Assistance office nearest to you. Our programs help you take a proactive approach to your own health by paying for a wide variety of services.

3 To get the most benefit, you should follow program guidelines, understand benefits available to you, work in partnership with your health care provider to use services wisely, and, most important, make healthy lifestyle decisions. By doing these things, you will help to maintain the integrity of alaska Medicaid and receive the care you need to maximize your overall health. If you have questions regarding any aspect of the programs, call the alaska Medicaid Recipient Helpline toll-free at Renee Gayhart Director Table of Contents About This Handbook .

4 1 Recipient Helpline .. 1 How alaska Medicaid Works .. 2 Proof of 2 Medicaid Card/Coupon .. 2 Denali KidCare Card .. 2 CAMA Card/Coupon .. 2 Care Management Program 2 Ho w to Use Your Medicaid .. 2 Other Medical Insurance/Health 3 Who is covered by alaska Medicaid ?.. 3 Medicaid Expansion .. 3 Family Medicaid .. 3 Denali 3 Ladies First Breast and Cervical Cancer 4 Long-Term Care .. 4 Home and Community-Based Waiver Services .. 4 TEFRA (Disabled Children at Home) .. 4 Adult Public Assistance Related Medicaid .. 4 Under 21 Medicaid .. 4 5 Medicaid coverage 5 Medicaid Covered Services.

5 6 Ambulatory Surgical Center 6 Behavioral Health 6 Community Behavioral Health Services .. 6 Eligibility for Community Behavioral Health 6 Other Outpatient Mental Health Services Providers .. 7 Inpatient Psychiatric Hospital and Residential Psychiatric Treatment Services. 7 Breast and Cervical Cancer 7 Chiropractic Services .. 7 Chiropractic Services for Children .. 7 Chiropractic Services for 7 Community First Choice Program .. 8 Dental Services .. 8 Dental Services for Adults .. 8 Dental Services for Children .. 9 9 Dialysis/End Stage Renal 9 Emergency Care.

6 9 Family Planning Services and Supplies .. 9 Hearing 9 Hearing Services for Adults .. 9 Hearing Services for 10 Repairs and Replacements .. 10 Home and Community-Based Waiver Services .. 10 Home Health 11 Hospice Care .. 11 Hospital Services .. 11 Lab/X-ray Services .. 12 Long-Term Care Facilities .. 12 Medical Equipment and Supplies .. 12 Durable Medical Equipment (DME) and 12 Prosthetic Devices .. 12 Home infusion therapy .. 12 Respiratory Therapy Assessment 12 Nutrition Services .. 12 Personal Care Services .. 13 Pharmacy Services .. 13 Prescription Drugs.

7 13 Pharmacy 13 Other Pharmacy 13 medicare Prescription Drug Plan .. 14 Physician and Advanced Practice Registered Nurse Services .. 14 Podiatry Services .. 14 Pregnancy and Postpartum Care .. 14 Private Duty Nursing .. 14 Private Duty Nursing Services for Adults .. 14 Private Duty Nursing Services for Children .. 14 Rural Health Clinic and Federally Qualified Health Centers Services .. 15 School-Based Services .. 15 Surgery .. 15 Therapy Services .. 15 Physical Therapy .. 15 Occupational Therapy .. 16 Speech-Language Therapy .. 16 Travel 16 Local Ground Transportation.

8 16 EPSDT Transportation .. 16 Travel Outside Your Home 16 Medicaid Travel 17 Travel Tips for alaska Medicaid 17 Travel Tips for Recipient Escorts .. 18 Frequently asked questions about Medicaid travel .. 19 Vision Services .. 21 Well Child Exams .. 22 Medical .. 22 22 Vision .. 22 Managing Your Care .. 23 How Medicaid Billing Works .. 23 Proof of Eligibility .. 23 Your Copayment .. 23 If you receive a bill .. 23 If you receive a payment for services paid by Medicaid .. 24 Retroactive or backdated eligibility .. 24 Service Authorization .. 24 Medical Care While Out of State.

9 24 Medicaid Renewal 25 Postpartum coverage .. 25 Ne wborn coverage .. 25 Ho w You Could Lose Your Medicaid Eligibility .. 25 Fraud and 26 Care Management Program .. 26 Fair Hearings .. 26 What is a Fair Hearing?.. 26 Ho w to request a Fair Hearing .. 27 Privacy and Confidentiality .. 27 Glossary .. 28 Medicaid Contacts .. 30 Medicaid Recipient Helpline .. 30 Medicaid Travel Offices .. 30 alaska Medicaid Travel Office .. 30 ANTHC Travel Management Office .. 30 TCC Patient Travel .. 30 YKHC Medicaid Patient Travel .. 30 Early Screening (EPSDT) Program Travel .. 30 Public Assistance District and Field 31 Other Resources.

10 32 alaska Medicaid Recipient Handbook | Revised June 1, 2020 | Page 1 About This Handbook The Department of Health and Social Services ( dhss ) is the state agency designated to administer the alaska Medicaid program, which includes: Medicaid Denali KidCare (DKC) Chronic and Acute Medical Assistance (CAMA) Updates to this Handbook are necessary from time to time as federal and state regulations are adopted. As updates are made, each affected part of the Handbook will be noted with the date of change. Changes made after the printing of this book will be made only to the online version, which is located on the Member tab alaska Medicaid Health Enterprise.


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